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and Martin, D (2021) Does duration of pain at baseline influence longer-term clinical outcomes of low back pain patients managed on an evidence-based pathway? Spine, 46 (3). pp. 191-197.

Objective The aim of this systematic review was to investigate the efficacy of sensory discrimination training (SDT) on sensorimotor performance in individuals with a neurological condition affecting the central nervous system. Methods MEDLINE, CINAHL, EMBASE, AMED, CENTRAL, PsychINFO, Scopus, OT Seeker, PEDro, ETHOS, Web of Science and OpenGrey were systematically searched for appropriate randomised controlled trials (RCTs). Included studies were assessed for risk of bias, and the quality of the evidence was rated using the GRADE approach. The protocol was registered on PROSPERO (CRD42017055237). Results Six RCTs met the inclusion/exclusion criteria. All studies used manual tactile discrimination to retrain somatosensation. Somatosensory effect sizes (0.12–0.92) and motor function effect sizes (0.12–10.39) ranged from trivial to large with narrative analysis revealing some between-group difference in favour of the intervention group. However, the total sample size ( n = 220) was relatively small, and the quality of the included studies was low. Conclusions SDT may have potential to be an efficacious treatment option for improving sensorimotor performance in individuals with neurological disease. However, at present there is limited evidence on which to base any firm clinical recommendations.

Objective: This scoping review aims to map the different working definitions currently being used for the duration of acute, subacute and chronic low back pain (LBP), and to establish where these definitions originated and the rationale provided for the timeframes used. Introduction: Low back pain is a major social and economic problem worldwide. One of the most commonly used approaches to classify and manage patients with LBP is the traditional duration-based classification (acute, subacute and chronic). There are significant differences between studies in the timeframes used for what constitutes acute, subacute and chronic LBP. These discrepancies lead to heterogeneity in study results, making it difficult to compare or summarize findings. Inclusion criteria: Studies that include participants with non-specific LBP, regardless of sex, will be considered. Studies that include children or participants with specific causes of LBP will be excluded. Methods: The following electronic databases will be searched: MEDLINE, Embase, CINAHL and PsycINFO. All types of studies will be included, provided they give a rationale for the definition of duration that they use. Studies will be limited to those published in English. Two independent reviewers will screen the retrieved articles against the eligibility criteria for the scoping review. A narrative synthesis will describe the definitions used in the study and the rationale given for the timeframes reported. This scoping review will give an insight into the background of the variation of timeframes used for duration-based classification of LBP.

ObjectivesEvaluate the outcomes and explore experiences of patients undergoing a residential combined physical and psychological programme (CPPP) for chronic low back pain.DesignA longitudinal observational cohort design, with a parallel qualitative design using semistructured interviews.SettingResidential, multimodal rehabilitation.Participants136 adults (62 male/74 female) referred to the CPPP, 100 (44 male/56 female) of whom completed the programme, during the term of the study. Ten (2 male/8 female) participated in the qualitative evaluation.InterventionA 3-week residential CPPP.Outcome measuresPrimary outcome measures were the STarT Back screening tool score; pain intensity—11-point Numerical Rating Scale; function—Oswestry Disability Index (ODI); health status/quality of life—EQ-5D-5L EuroQol five-Dimension-five level; anxiety—Generalised Anxiety Disorder-7; depression—Patient Health Questionnaire-9. Secondary outcome measures were the Global Subjective Outcome Scale; National Health Service Friends and Family Test;.ResultsAt discharge, 6 and 12 months follow ups, there were improvements from baseline that were greater than minimum clinically important differences in each of the outcomes (with the sole exception of ODI at discharge). At 12 months, the majority of people considered themselves a lot better (57%) and were extremely likely (86%) to recommend the programme to a friend. The qualitative data showed praise for the residential nature of the intervention and the opportunities for interaction with peers and peer support. There were testimonies of improvements in understanding of pain and how to manage it better. Some participants said they had reduced, or stopped, medication they had been taking to manage their pain.ConclusionsParticipants improved, and maintained long term, beyond minimum clinically important differences on a wide range of outcomes. Participants reported an enhanced ability to self-manage their back pain and support for the residential setting.